Narimani Rouhollah, Kachuei Ali, Rezvanian Hassan, Feizi Awat, Poorpoone Mohadese
Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2021 Jun 30;26:35. doi: 10.4103/jrms.JRMS_78_20. eCollection 2021.
Diabetic nephropathy, the leading cause of chronic renal failure, is related to diabetes poor control. Some antihyperglycemic drugs like dipeptidyl peptidase-4 inhibitors have shown to prevent diabetic nephropathy. This study endeavors to assess the effect of sitagliptin on proteinuria in Iranian type 2 diabetics.
A total of 90 type 2 diabetic patients aged between 30 and 80 years with glycated hemoglobin (HbA1C) <8.5 and normotensive under treatment of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were randomly assigned into two groups. One group received 50 mg sitagliptin per day and the other group received placebo. The two groups were evaluated for albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) at baseline and 3 months later.
Eighty-four patients, 38 (45%) males and 46 (55%) females, were enrolled in this study. The mean age was 58.47 ± 7.33. The two groups did not differ in baseline characteristics. After 3 months, in the sitagliptin group, HbA1C (7.89 ± 0.39 to 7.37 ± 0.61, < 0.001), fasting blood sugar (FBS) (136.86 ± 22.51 to 130.53, = 0.04), systolic blood pressure (BP) (124.39 ± 9.70 mmHg to 119.32 ± 9 mmHg), diastolic BP (76.44 ± 6.53 to 73.13 ± 5.34 mmHg, < 0.001), and ACR (314.40 ± 414.64 to 293.49 ± 400.71, < 0.001) were significantly decreased and eGFR was significantly increased (73.35 ± 10.73 to 76.86 ± 10.59, < 0.001) at 3 months compared to the placebo group. ACR reduction was higher in macroalbuminuric (Ma) patients compared to microalbuminuric (Mi) patients in the sitagliptin group (-30.25 ± 35.57 vs. -11.12 ± 14.01, = 0.02). No significant difference was observed between the Ma and Mi subgroups regarding changes in eGFR. Univariate analysis showed that changes in ACR correlated with FBS (r = 0.68, < 0.0001), insulin (r = 0.44, = 0.03), and homeostatic model assessment for insulin resistance (r = 0.69, < 0.0001) and did not correlate with eGFR and BP.
In conclusion, sitagliptin is a well-tolerated drug that improves glycemic control, lowers BP, and reduces urinary albumin excretion, especially in Ma type 2 diabetic patients.
糖尿病肾病是慢性肾衰竭的主要原因，与糖尿病控制不佳有关。一些降糖药物如二肽基肽酶-4抑制剂已被证明可预防糖尿病肾病。本研究旨在评估西他列汀对伊朗2型糖尿病患者蛋白尿的影响。
总共90例年龄在30至80岁之间、糖化血红蛋白（HbA1C）<8.5且在接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗时血压正常的2型糖尿病患者被随机分为两组。一组每天服用50毫克西他列汀，另一组服用安慰剂。在基线和3个月后对两组进行白蛋白-肌酐比值（ACR）和估计肾小球滤过率（eGFR）评估。
84例患者纳入本研究，其中男性38例（45%），女性46例（55%）。平均年龄为58.47±7.33。两组基线特征无差异。3个月后，与安慰剂组相比，西他列汀组的HbA1C（从7.89±0.39降至7.37±0.61，<0.001）、空腹血糖（FBS）（从136.86±22.51降至130.53，=0.04）、收缩压（BP）（从124.39±9.70 mmHg降至119.32±9 mmHg）、舒张压（从76.44±6.53降至73.13±5.34 mmHg，<0.001）和ACR（从314.40±414.64降至293.49±400.71，<0.001）显著降低，eGFR显著升高（从73.35±10.73升至76.86±10.59，<0.001）。在西他列汀组中，与微量白蛋白尿（Mi）患者相比，大量白蛋白尿（Ma）患者的ACR降低幅度更高（-30.25±35.57对-11.12±14.01，=0.02）。Ma和Mi亚组之间在eGFR变化方面未观察到显著差异。单因素分析显示，ACR变化与FBS（r = 0.68，<0.0001）、胰岛素（r = 0.44，= 0.03）和胰岛素抵抗的稳态模型评估（r = 0.69，<0.0001）相关，与eGFR和BP无关。
总之，西他列汀是一种耐受性良好的药物，可改善血糖控制、降低血压并减少尿白蛋白排泄，尤其是在Ma型2型糖尿病患者中。
